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Your rotator cuff is a group of muscles and tendons that surround your shoulder. These tendons stabilise and strengthen your shoulder socket as you move it. You use your rotator cuff countless times each day to perform all manner of tasks. For example, reaching to put an item on your shelf or stretching your arm behind your back when putting your jacket on.
Being a well-used joint means that your shoulder can become damaged easily, and when this damage is to your rotator cuff it can significantly impact your life, causing pain and restricting movement in your upper body. This can stop you living life like normal.
Most people with painful or damaged rotator cuffs won't need surgery. Often the problem will heal over time, or can be managed using conservative treatments such as physiotherapy. However, if your shoulder pain is impacting your quality of life, and other methods can't improve it, rotator cuff surgery could be the right choice for you.
If you think you need shoulder surgery, whether you have been given a referral already or are looking for a second opinion, give us a call or book online today and one of our experienced consultants will help you find the right treatment for you.
General wear and tear
Degenerative changes (also known as a type of arthritis called osteoarthritis) can happen across your joints as a natural result of ageing. Wear and tear occurs when small fibres in your tendons break down, causing pain and swelling.
Rotator cuff tear
Rotator cuff tears are a common injury and become more common with age, particularly over the age of 40. You can get a tear in your rotator cuff either by an injury to your shoulder (acute tear) or from degenerative changes in the joint over a period of time (chronic tear).
Acute tear: You may tear your rotator cuff as a result of a fall, or a hard blow to the shoulder while playing a contact sport like rugby. This puts excess stress through the rotator cuff tendons, leading to a tear.
Chronic tear: As we age, our joints naturally experience more wear and tear. We believe that over time the tendons may become gradually more worn as they rub against bone, eventually causing them to tear. A chronic tear may also result from overusing your shoulder. When overused the tendons will often become irritated, causing them to swell up and rub more on surrounding bones as they move.
Rotator cuff tear arthropathy
This is a term to describe a type of arthritis that affects your rotator cuff. It develops gradually as a result of wear and tear caused by a torn rotator cuff. Arthropathy generally describes joint disease, which can caused a range of distressing symptoms, including pain, stiffness, and swelling.
Tendonitis of the shoulder
Tendonitis is a familiar term used to describe pain and inflammation to any tendon. It is most commonly caused by overuse, but can also be caused by infection, rheumatoid arthritis, or osteoarthritis.
Non-surgical management
If your rotator cuff was torn through injury, a period of watchful waiting is often recommended, to see how much your shoulder recovers naturally before deciding on treatment. If you do need treatment, non-surgical options will be recommended first.
Exercises
A rotator cuff tear can be managed effectively by following a regular exercise routine to optimise strength and coordination of the affected shoulder joint.
Using painkillers when needed
Over-the-counter analgesia is available at your local pharmacy, should you need it. Paracetamol is the most commonly recommended. Anti-inflammatories such as Ibuprofen are also used to help shoulder pain, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. The Versus Arthritis website has lots of useful information about the various drug options to treat arthritis pain.
Physiotherapy
Physiotherapy can be offered as a treatment for shoulder pain. This involves a physical assessment and discussion about how your symptoms are impacting your life, followed by developing a treatment plan together. Treatment can include:
- Exercises form the mainstay of treatment, with advice regarding exercises to improve flexibility and reduce the sensitivity of the muscles, joints and nerves. Some strength exercises can also be recommended to help improve the strength and function of the tendons and shoulder joint
- Manual Therapy, such as manipulation, mobilisations and soft tissue massage, will usually form a small portion of your treatment
- Advice to help you speed your recovery and avoid aggravating symptoms
- Corticosteroid injection therapy (these injections are best avoided in the presence of a rotator cuff tear but may be considered by your clinician in specific circumstances)
Surgical management
Surgical rotator cuff tendon repair is a highly invasive operation which normally requires 4-8 weeks of immobilisation of the operated shoulder and extensive, prolonged rehabilitation following surgery. Because of this, many individuals opt to manage their condition non-surgically even if there is some reduction in their ability to use the affected arm.
For patients who are willing to consider a surgical repair this decision is best discussed with your consultant as the effectiveness of this operation varies greatly according to individual characteristics including:
- Your age (outcomes after rotator cuff repairs worsen with increasing age; your consultant will discuss the implications of this with you directly)
- The exact location and size of your tendon tear (partial thickness tears will need to have trialled at least 3 months of non-surgical management before considering surgery)
- Whether the tendon tear was traumatic (through an injury) or degenerative (age-related) in nature
The procedure will be similar whether there is a specific tear to your rotator cuff or more general damage. You will usually be under general anaesthetic for the operation, meaning you will not be awake.
Most rotator cuff repairs are completed through a form of keyhole surgery known as arthroscopy. This method uses a thin metal tube with a camera at the end of it (known as an arthroscope), which is connected to a monitor that displays images of inside your shoulder for your consultant to refer to as they perform the surgery.
If your tendon is not torn completely, your consultant can use surgical instruments to repair it with stitches. These are attached to bone anchors, which are hammered or screwed into your bone. Your consultant will finish by closing the stitches and placing dressing over the incisions. It typically takes up to an hour to perform rotator cuff repair surgery as keyhole surgery.
If your tear is larger, 'open' surgery may be performed instead. Open surgery uses a larger incision to directly access your rotator cuff. The procedure can take up to two hours and is also performed under general anaesthesia.
You can usually see an orthopaedic specialist for your initial consultation within 48 hours of booking your appointment with us. Orthopaedics is the area of medicine that looks after our joints and muscles.
During this initial appointment, your consultant will ask in detail about your general health and your medical history. They will want to know about any existing medical conditions, as well as the current shoulder pain symptoms you are experiencing. They'll ask you how these symptoms impact your everyday life, how often they occur, and whether you have had any treatment for them yet.
In order to assess your symptoms and make an accurate diagnosis of your shoulder pain, your consultant will next carry out a gentle physical examination of your joint. In some cases they might also send you to get an X-ray, which will be done onsite by one of our radiologists. All of this helps your consultant to make a diagnosis of the cause of your pain.
Once they have identified what's causing your problems, they will share more information about rotator cuff repair surgery and whether it could be the right treatment for you.
Your initial consultation is an important and positive step in your journey towards improved mobility and reduced joint pain. It's where we start to get to know you as an individual and it's from the information we find out during this session that we will start building a treatment plan, bespoke to your needs. To make the most of the initial consultation, you should feel free to talk as openly and honestly as you like about the pain and other symptoms you're experiencing, the way they make you feel, and what you're hoping to get from surgery.
The time you'll wait between your initial consultation and having surgery (or any other treatment you're recommended) will differ from person to person. For example, someone who has suffered a traumatic injury may need to be seen very quickly, while other situations won't be as urgent. However, you should not expect to be waiting a long time for your surgery. We look to get you booked in as soon as possible, on a day that suits you, and we don't delay or reschedule treatment except in emergencies.
Remaining generally healthy and fit on the run-up to surgery helps reduce your risk of developing complications from the operation and can even speed up your recovery. In preparation for the procedure, we recommend that you:
- Stop smoking
- Eat a healthy, balanced diet
- Exercise regularly
- Lose weight (if you are overweight)
You will also have blood tests and a general health check with your consultant before surgery to ensure you are healthy enough for the procedure.
You will be able to ask your consultant as many questions as you would like about the procedure and how to prepare for it. They will offer tailored advice based on your circumstances, including whether you need to stop taking certain medications prior to surgery.
Changes to your medication
Your consultant will also share information on whether you should avoid taking your usual medication before going into hospital, or the kind of medication you might need to take after you have surgery.
Eliminate tripping hazards at home
Remember to eliminate any tripping hazards such as uneven flooring (this could be anything from uneven tiles to loose rugs and carpets) or general mess in your home before surgery. This is to ensure you don't trip and injure your shoulder further after surgery.
Making your home recovery friendly
In the weeks after your surgery, your mobility will be limited as you recover. We recommend stocking up your house with food and resources or arranging for a friend or family member to do so.
You'll also need to think about how you will return home from hospital, and have this arranged before you come in for surgery. Perhaps a friend or family member can give you a lift, or maybe you'd rather book a taxi. We can arrange for a taxi to collect you from hospital, if needed.
Depending on the extent of your injury, rotator cuff surgery can be performed as either open surgery or by arthroscopy (also known as keyhole surgery).
Many rotator cuff tears can be carried out using as keyhole surgery. Arthroscopy involves inserting a thin metal tube with a camera and bright light at one end (this is known as an arthroscope) through small cuts made in your shoulder joint. Your consultant insert specialist surgical instruments through the arthroscope and to repair the wear and tear in your shoulder. This involves re-attaching the tendon to the head of your humerus (upper arm bone).
If you have a larger tear, “open” surgery may be required. This involves a larger cut being made over your shoulder and the rotator cuff tear being repaired with stitches and bone anchors.
Arthroscopy involves inserting a small camera, called an arthroscope, through a few small incisions, and passing surgical instruments through these incisions to treat the shoulder joint.
If you have a larger tear, open surgery may be required and a larger cut over your shoulder will be made. Bone spurs may also be removed to prevent the rotator cuff tendons from rubbing against the bone. The surgery itself is usually performed under a general anaesthetic, however a variety of anaesthetic techniques are possible.
During the surgery, your surgeon may use instruments to remove any thickened tissue, release any tight tissue and to shave off some bone.
If you have a large tear, your surgeon will repair the rotator cuff using stitches that anchor into the bone.
Recovery time for rotator cuff surgery depends on a number of factors, including:
- The size of any wear and tear
- How long you have had rotator cuff wear and tear
- How diligently you stick to your exercise and stretching programme set by your physiotherapist
Recovering in hospital
Immediately after surgery, you will feel some numbness in your shoulder as the anaesthetic wears off (this will take up to 24 hours). We will leave your arm in a sling to make movement easier for you. As the anaesthesia wears off at home, you will probably feel some pain and discomfort in your shoulder. This can be managed with traditional painkillers.
Throughout your recovery, your physiotherapist will work with you to help you regain mobility and strengthen your rotator cuff wear and tear safely. They will show you these exercises when you wake up in hospital and ensure you have the tools and information to perform them safely at home. You will usually be able to leave hospital and return home after around one to two days after your operation.
Two to six weeks after surgery
You can start incorporating gentle exercise back into your routine after two to six weeks. It's different for everyone, and your surgeon and physiotherapist will have explained to you what to do and how to know when you're ready. Going on long, slow walks can really help you build up your fitness and mobility again. Do not return to high-impact activity or sport until your consultant advises it's okay.
You can also usually return to work at this stage, depending on the type of work you do. Most people with office jobs are able to go back into work, but if you have a manual or physical job you will probably need more time off. Again, your consultant will have talked you through all these factors.
Driving after surgery
You should speak to your consultant about whether you can drive again, as this will depend on the progress of your recovery. You should also talk to your car insurance provider, as they may have specific rules about when you can drive after surgery.
Eight to twelve weeks
About eight to 12 weeks after surgery, you should be well on the way to a full recovery and able to carry out everyday activities with ease. Full recovery will probably take you more like six to 12 months, however most people feel most of the way back to their normal selves at around ten or 12 weeks post-surgery.
Physiotherapy after rotator cuff repair surgery
Physiotherapy is a very important part of your recovery journey at Circle Health Group. How well you follow the guidance of your physiotherapist can have a huge impact on how well and how quickly you recover.
You will meet your physiotherapist at the hospital after your operation, if not before. They will get to know you and your individual circumstances, and they'll tailor your specialised recovery programme so that it's bespoke to you. This plan will be made up of exercises to strengthen your shoulder and arm muscles and improve your mobility and the range of motion in your shoulder. These exercises can accelerate your recovery timeline.
Your physiotherapist will let you know how regularly you should do these exercises outside of your sessions, and they'll help you source ant equipment you might need to help you do them. They'll also give you advice on how to incorporate exercise into your daily routine at home, so that your physiotherapy becomes a normal part of your day.
Any surgical intervention has risks of complications such as pain and bleeding. Complications specific to rotator cuff surgery include:
- Bleeding into your shoulder
- Restricted shoulder movement
- Infection in your shoulder
- Blood clot
- Nerve injury
Your consultant will reassure you by explaining the likelihood of these complications./p>
Do I have to wear a sling to bed after rotator cuff surgery?
Wearing a sling after surgery helps keep your arm in a proper position, protecting it from being injured during your recovery period. We recommend wearing your sling during the day and in bed. Your consultant will advise how long you should wear the sling for in total.
How painful is your rotator cuff after surgery?
You will have pain and swelling for a few weeks after surgery, but this can be managed with painkillers and physiotherapy exercises. Some people find their pain eases after just a few days after surgery, but this depends on the individual.
How soon after shoulder surgery can I drive?
We recommend avoiding driving after shoulder surgery for at least six weeks, but you should speak with your consultant for an exact timeframe for this.
Does a torn rotator cuff hurt all the time?
Torn rotator cuffs often feel more painful at night and may even wake you up. During the day, the pain is generally more tolerable, but can still be aggravated by certain movements and activities. But no person experiences a torn rotator cuff in the exact same way.
When you choose to go private with Circle Health Group, you can expect:
- Flexible appointment times and locations to fit your routine
- The freedom to choose which hospital and consultant suit your needs
- Personalised, consultant-led treatment plans tailored to your individual needs
- Comfortable and safe private facilities maintained by expert multidisciplinary teams
- Support by the same compassionate clinical team from beginning to end
- Affordable, fixed-price packages with aftercare included
- Flexible payment options to help you spread the cost of your care
If you would like to learn more about treatments for shoulder pain, book your appointment online today or call a member of our team directly on 0141 300 5009.
Content reviewed by Circle in-house team in August 2022. Next review due August 2025.
- Rotator Cuff Tears: Surgical Treatment Options, OrthoInfo
- Rotator Cuff Repair, Johns Hopkins Medicine
- Do I Need Surgery for a Rotator Cuff Problem?, WebMD
- Rotator cuff repair - Information for patients, NHS South Tees Hospital
- Rotator Cuff Tear: When to Repair and When to Smooth and Move the Shoulder, UW Medicine
